The following sample questions are representative of actual test content, difficulty level, and question format. The answer key follows the set of questions.
Directions: Each question or incomplete statement below is followed by four suggested answers or completions. Select the one that is best in each case.
An APN discusses with the patient that the advantage of sentinel lymph node biopsy over conventional axillary lymph node dissection is that it:
- reduces the need for postoperative chemotherapy.
- eliminates the need for postoperative radiation.
- reduces the risk of postoperative re-excision.
- reduces the risk of an unnecessary morbidity.
A patient is referred to the APN for evaluation of bone pain, recurrent bacterial infections, blurred vision, and fatigue. The APN is most concerned about:
- high iron stores.
- elevated hematocrit.
- elevated serum total protein.
- macrocytic anemia.
The APN palpates an abdominal mass in a patient with a chief complaint of weight loss, flank pain and gross hematuria. The APN orders:
- prostate biopsy.
- intravenous urography.
- CA-125 level.
- prostate-specific antigen test.
A patient is scheduled for external beam radiation therapy to the chest wall. The APN discusses which treatment side effect with the patient?
5. A patient who had an allogeneic hematopoietic stem cell transplant 60 days ago presents with maculopapular rash over less than 25% of the body, bilirubin 2.7 mg/dl, and persistent nausea. The APN orders a(n):
- skin biopsy.
- barium swallow.
- intestinal biopsy.
- abdominal computed tomography scan.
Rationale: Sentinel lymph node biopsy is a highly accurate technique for determining regional metastasis and staging information for patients with melanoma and breast cancer tumors less than 5 cm. The accuracy rate is 97%. Patients with negative sentinel nodes may not require additional axillary surgery.
Reference: DeVita, V.T., Jr., Lawrence, T.S., & Rosenberg, S.A. (Eds.). (2011). Cancer: Principles and practice of oncology (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins, pp. 1423-1424.
Rationale: Multiple myeloma should be suspected when a patient presents with bone pain in which lytic lesions are discovered on radiographic films. An increase in serum total protein or presence of M-protein in the serum or urine, new-onset renal failure without an obvious cause, or hypercalcemia strongly suggests the diagnosis of multiple myeloma.
Reference: Yarbro, C.H., Wujcik, D., and Gobel, B.H. (Eds.). (2011). Cancer nursing: Principles and practice (7th ed.). Sudbury, MA: Jones and Bartlett, p. 1515.
Rationale: The classic diagnostic triad of gross hematuria, costrovertebral pain, and a flank mass is estimated to occur in only 10% to 20% of patients with renal cell cancer. Additional presenting symptoms include weight loss, anorexia, or symptoms arising from metastatic sites and paraneoplastic syndromes. Intravenous urography is often the initial diagnostic procedure done to evaluate nonspecific symptoms including flank pain or hematuria: it assesses the urothelial tract.
Reference: Yarbro, C.H., Wujcik, D., and Gobel, B.H. (Eds.). (2011). Cancer nursing: Principles and practice (7th ed.). Sudbury, MA: Jones and Bartlett, p. 1637.
Rationale: The side effects of radiation should be discussed with the patient before the start of therapy. Patients have varying degrees of side effects, especially skin reactions. These include itching, erythema, dryness, wet desquamation, rash, loss of hair, radiation-induced necrosis, and general discomfort.
Reference: Yarbro, C.H., Wujcik, D., and Gobel, B.H. (Eds.). (2011). Cancer nursing: Principles and practice (7th ed.). Sudbury, MA: Jones and Bartlett, p. 1070.
Rationale: The patient presents with Grade I graft versus host disease. The diagnosis needs to be confirmed with a skin biopsy.
Reference: Gobel, B.H., Triest-Robertson, S., & Vogel, W.H. (Eds.). (2009). Advanced oncology nursing certification review and resource manual. Pittsburgh, PA: Oncology Nursing Society, pp. 277-279.